public citizen report

8/4/2019 Public Citizen Report

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March 2011

State Medical Boards

Fail to DisciplineDoctors With Hospital

Actions Against ThemBy Alan Levine

Robert Oshel, PhD

Sidney Wolfe, MD

www.citizen.org


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STATE MEDICAL BOARDS FAIL TO DISCIPLINE DOCTORS WITHHOSPITAL ACTIONS AGAINST THEM

Executive Summary:

An analysis of the National Practitioner Data Bank Public Use File for 1990-2009 foundthat of a total of 10,672 physicians in the data bank with one or more clinical privilege

actions revocation or restriction of their clinical privileges 45% also had one ormore state licensing actions. However 5,887, or 55%, of these physicians more thanhalf had no state licensing actions. This report is an analysis of violations by and theprivileging actions taken against these physicians who, despite clinical privilege actions,escaped any state licensing action.

Types of violations causing Clinical Privileging Actions

The reason for the actions against these 5,887 physicians included:

220 physicians disciplined because they were an Immediate Threat to Health orSafety

1,119 physicians disciplined because of incompetence, negligence or malpractice 605 physicians disciplined because of substandard care

Other categories of serious deviations of physician behavior/performance that resulted inclinical privilege revocation or restrictions included Sexual Misconduct, Unable toPractice Safely, fraud, including insurance fraud, fraud obtaining a license, and fraudagainst health care programs, and narcotics violations.

Thus, a total of 2,071 physicians (35% of those physicians with clinical privilege actions

but no medical board actions), had one or more of the above most serious categories ofviolations.

Types of Clinical Privileging Actions taken against the 5,887 physicians

3,218 physicians in our study lost their clinical privileges permanently, and an additional


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In addition, many of the 5,887 physicians who had been disciplined by hospitals, but hadno state medical board action, had a history of medical malpractice payments (as reported

to the NPDB). A physician in New Mexico had 26 malpractice cases while a physician inIndiana had 20. Fourteen states had a physician with at least one clinical privilege report,no state licensure action, and at least 10 medical malpractice payments.

Hospital disciplinary reports are peer review actions that are one of the most importantsources of information for medical board oversight. Subsequent state medical boardaction against a physicians license provides a greater assurance than a hospitaldisciplinary action alone that the practitioners medical practice would be monitored or

limited and that other state medical boards and future employers will have a morecomplete account of a practitioners practice history.

Our analysis of physicians with clinical privilege reports but no state licensure actionraises serious questions about whether state medical boards are responding adequately tohospital disciplinary reports and whether, as required by federal law, state medical boardsare receiving such reports.

Because the NPDB Public Use File de-identifies physicians through the use of codenumbers, Public Citizen is asking state medical boards to work cooperatively with theHealth Resources and Services Administration, which operates the NPDB, to identify thephysicians in our study and take the appropriate action.


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Public Citizen Analysis of Physicians with NPDB Clinical Privilege ReportsBut No State Licensure Action

The Problem

Public Citizen is concerned that many physicians with peer-reviewed clinical privilegesanction reports in the National Practitioner Data Bank (NPDB) have not had asubsequent state medical board licensure action.1 While not all clinical privilege reports

to the NPDB would necessarily result in state board action, the large number ofphysicians (5,887) determined by our analysis to have had one or more clinical privilegereports but no state licensure action suggests that boards are not properly acting on suchreports after becoming aware of them, and, secondarily, that hospitals may not be sendingsuch reports to all of the appropriate state licensure board(s) where the doctor is known tobe licensed.

2

State medical board action against a physicians license, if warranted, provides a greaterassurance than a hospital privilege action alone that (a) the practitioners medical practicewould be monitored, limited or curtailed by a medical board order and (b) other statemedical boards and future employers will have a more complete account of apractitioners practice history.3

Understanding the Problem

Concern about medical boards oversight of physicians performance is not new. In a1988 report, the now closed Congressional Office of Technology Assessment noted thatState Boards are reluctant to censure physicians and accord accused physiciansextensive opportunity for appeal4

1 Clinical privilege report refers to a peer review based disciplinary action that is taken by a hospital ormanaged care organization or other health care entity. If a physicians privileges to practice in the healthcare organization are limited or revoked for a period of more than 30 days, the action must be reported tothe National Practitioner Data Bank, which is a national clearinghouse of doctor disciplinary and medicalmalpractice information operated by the Department of Health and Human Services and available to onlyhealth care organizations and State medical boards.2 Hospitals and other reporters are required to send a copy of each clinical privilege report directly to therelevant state licensing board. The relevant board is determined by the facility reporting the clinicalprivilege action and is probably but not necessarily the licensing board in the facilitys state For example


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In February 1997, June Gibbs Brown, the Inspector General at the Office of InspectorGeneral (OIG), Department of Health and Human Services (HHS), testified before

Congress, as follows:

In February 1992, the OIG excluded a California oncologist for 10 years because theOIG determined that he had rendered over 3,900 excessive, substandard, unnecessary,and potentially risky services to seven Medicare beneficiaries over a six year period oftime Once the exclusion was in place, the licensing board did revoke the doctorslicense. Then it stayed the revocation and put the license on probation. The stay has beenlifted but if the OIG had not devoted its investigative power to excluding this

physician, the Medicare/Medicaid patient population would have continued to be at graverisk during the four years that the licensing board took to get to an exclusionable point inits process.

5

Methodology

We analyzed the NPDB Public Use File and extracted information about 5,887physicians (identified in this file only by a coded number) who had at least one clinical

privilege report in the NPDB but no medical board licensure action report in the NPDB.For the purposes of our analysis, these physicians were assigned to a state based on thestate in which the last clinical privilege action occurred. Thus, a physician may have hadtwo clinical privilege actions reported in state A, but the third and most recent report wasfor state B. The physician in this example would have been assigned to state B for thepurposes of our analysis. This means that, by definition, for the state-stratified data in thisreport, every state that is counted as having failed to take a license action after a previoushospital action is the same state in which the most recent hospital action occurred. Inaddition, if a physician with one or more clinical privilege actions had a licensing boardaction in any state, the practitioner was not included in our study.

We examined the following: (1) the number of clinical privilege reports per physician,nationally and by state; (2) the number of clinical privilege reports for reasons that wouldmuch more likely warrant a medical board action, such as Immediate Threat to Health orSafety, incompetence and sexual misconduct; and (3) the number of medical malpractice

payment reports for the 5,887 physicians with one or more clinical privilege actions butno board licensure action in our study. Unless otherwise noted, the data in the report andin the exhibits cover the period from September 1, 1990, the date the NPDB startedcollecting data, through December 31, 2009.

Clinical privilege actions, which totaled 8,734 reports (involving 5,887 physicians) in our


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Findings

Clinical Privilege Reports Per Physician,Nationally

Table 1 shows the number of physicians with one or more clinical privilege reports butno state board action, stratified by the number of reports per physician. For example, itcan be seen that 125 physicians have had four clinical privilege reports without any statelicensing action while three physicians have had 12. Of a total of 10,672 physicians in thedata bank with one or more clinical privilege actions, 45% had one or more state

licensing actions, but 5,887, or 55%, more than half had no state licensing actions.

Table 1

Physicians with Adverse Clinical Privilege Reports to the NPDB

But No Licensure Board Action

Number of Adverse Clinical PrivilegeReports Per Physician

Number of Physicians with Specifiednumber of Adverse Clinical PrivilegeReports But No Licensure Action

1 4056

2 1250

3 350

4 125

5 56

6 27

7 12

8 59 2

10 1

12 3

Total Physicians With One or More Clinical PrivilegeReports But No Licensure Report: 5887

Hospitals, managed care organizations and other health care entities that do peer reviewhave 40 codes available to categorize the nature of the action taken in a clinical privilegereport, such as revocation, termination and voluntary surrender while underinvestigation.7 They also have 62 codes available to explain the basis for actions that


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were taken. These bases for action codes the offenses of the doctors resulting in thesecredentialing actions include the following: immediate threat to health or safety,

incompetence, substandard or inadequate care, inability to practice safely by reason ofalcohol or substance abuse, and sexual misconduct.

Clinical privilege sanctions for very serious reasons, some of which are listed above,should be particularly important triggers for state medical board investigation andprobable licensure action. However, our analysis of clinical privilege reports with nolicensure board action in this study found 2,401 clinical privilege reports involving 2,071physicians for performance and conduct reasons that would seem to warrant medical

board action. As can be noted in Table 2, there were 243 reports with a Basis forAction code indicating that the physician was an Immediate Threat to Health orSafety. The 243 reports involve a total of 220 physicians; 197 of these physicians withno licensure report have one such code while 23 of the practitioners had two such codes,i.e. there were two hospital actions taken against these 23 practitioners for being anImmediate Threat to Health or Safety.

The seriousness of the hospital action for these physicians is made even more evident by

our analysis of NPDB Public Use File data showing that of the 220 physicians who werefound to constitute an Immediate Threat to Health or Safety:

For 167 (75%) of these 220 physicians, the hospital took an immediate action, i.e.Summary/Emergency Suspension of privileges" or Summary or EmergencyLimitation, Restriction, or Reduction of Clinical Privileges.

For 42 (21%) of these 220 physicians, the hospital revoked or suspended theirprivileges.

Thus, for the 209 or 94% of these 220 physicians who constituted an Immediate Threatto Health or Safety, the hospital took one of the very serious actions cited above. Theremaining reports involved non-summary actions. However, according to the NPDBPublic Use file, state boards did not take any action against any of the 209 physicians thatwere considered such a threat.

As seen in Table 2, there were a total of 2,401 clinical privilege actions against 2,071physicians based on this most serious group of reasons for the clinical privilege action.This means that 2,401 out of the total number of clinical privilege reports 8,734 or27.5 percent that did not result in any state board actions were in these most seriouscategories. At the level of physicians, this means that 2,071 of the 5,887 physicians with


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5,887 physicians in our study may no longer be practicing, but if that is indeed the case, itwas their own decision and not the result of a medical licensure board action.

Furthermore, if a physician gives up his/her medical license during a medical boardinvestigation, it is still a reportable action to the National Practitioner Data Bank as avoluntary surrender. Such medical board actions, if they were properly reported to theNPDB, would have been taken into account in our analysis; i.e., they were counted as alicensure action and excluded from our analysis.

Table 2

Basis for Action and

Basis for Action Reporting Code

Number of

Reports

Number of

PhysiciansImmediate Threat to Health or Safety (Code F1) 243 220

Incompetence/Malpractice/Negligence(Code 52: used only until November 12, 1999)*

1072 910

Incompetence (Code 11) 165 152

Malpractice (Code 12) 29 27

Negligence (Code 13) 31 30

Sexual Misconduct (Code D1) 31 30

Criminal Conviction (Code 19) 24 23

Unable to Practice Safely (Codes F3,F4,F5) 74 72

Fraud in Obtaining License/Credentials (CodesE4,09)

24 24

Fraud (unspecified) (Code 05) 28 25Insurance Fraud (against Federal and Non-FederalHealth Care Programs) (Code 06,08)

2 2

Narcotics Violation or Other Violation of DrugStatutes (Code H1)

13 10

Diversion of Controlled Substance (Code H6) 4 4

Practicing without a Valid License (Code A4) 4 4

Substandard Care (Code F6,F7) 657 605

Total actions with most serious basis for action 2401 2071**

*Code 52 was changed in November 1999 and separate codes were established foreach category.

** This is an unduplicated count of physicians. A total of 67 physicians have reports


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clinical privilege actions for physicians who had not had a state licensure action. Whenreporting the length of a penalty, reporters can specify that the penalty has an indefinite

period, or that the period is a time frame that they state in the report (e.g., nine months orthree years), or that the penalty is permanent. The length of the penalty is reportedindependently of the type of penalty (e.g., revocation, suspension, limitation).

We found the following:

There were 3,679 sanction reports with permanent penalty, which represents 42percent of all clinical privilege reports in our analysis that did not result in state

medical board discipline. These reports involve a total of 3,218 doctors, each ofwhom has from one to five reports with permanent penalties. Since there were5,887 physicians in our study, a total of 54.7% of the practitioners with one ormore clinical privilege sanction but no medical board action have at least onepermanent penalty. Specifically, 300 of these doctors have two permanent penaltyreports, 55 have three permanent penalty reports, 13 have four permanent penaltyreports and three have five permanent penalty reports.

There were 1,143 sanction reports involving 986 physicians with specifiedpenalty length, which represents 13.1% of clinical privilege reports in our study.We further analyzed these 1,143 reports to determine the length of the penalty.We found:

394 reports involved a penalty of from one to four years 30 reports involved a penalty from 5 through 11 years These 434 reports involved 389 physicians

There were 3,580 reports with indefinite penalty length, which represents 41percent of all clinical privilege reports and involves 2,775 physicians.

Thus, a total of 3,607 (3,218 plus 389) physicians, representing 61% of those with one ormore clinical privilege reports but no state disciplinary action, had either a permanentpenalty or a penalty of one year or more.

This is yet another way of demonstrating that very serious actions by hospitals are notfollowed by any action by many medical boards.

State-by-State Analysis of Clinical Privilege Reporting

Exhibit B lists the number and percent of physicians, by state, with NPDB clinical


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Delaware Hawaii, Indiana, New Mexico, Nevada, Pennsylvania, South Dakotaand Tennessee.

In seven states, 60% to 69% of the physicians with clinical privilege sanctionreports had no state licensure action. These states are: Florida, Georgia, Illinois,Montana, Nebraska, Texas and Wisconsin.

In 17 states plus the District of Columbia, 50% to 59% of the physicians withclinical privilege sanction reports had no state licensure action. These statesare: Alabama, Alaska, Arkansas, California, Idaho, Kansas, Michigan,Missouri, North Carolina, New Hampshire, New Jersey, New York, Ohio,Oklahoma, South Carolina, Utah and Washington.

Thus, in 32 states plus the District of Columbia, 50 percent or more of the physicianswith clinical privilege actions had never had a state licensing action in that state or anyother state.

For all states in the U.S., we examined the number of clinical privilege reports perphysician with no licensure reports. We found the following:

Three states (California, Minnesota and Missouri) each had a physician with 12clinical privilege reports but not even one state licensure report.

Indiana had a physician with 10 clinical privilege reports but no licensure reports. Nebraska and California each had a physician with nine clinical privilege reports

but no licensure reports.

Four states (Maryland, New Jersey, New York, and South Carolina) each had aphysician with eight clinical privilege reports but no licensure reports.

Nine states (Alabama, California, Massachusetts, Nebraska, Ohio, Oklahoma,South Carolina, Texas and Washington) each had a physician with seven clinicalprivilege reports but no licensure reports.

See Exhibit C for a table showing for each state the number of physicians with specifiednumbers of clinical privilege reports but no licensure board action.

Clinical Privilege Sanctions and the Likelihood of a Medical Malpractice Payout for

Those Physicians without a State Licensing Board Action

According to research done by National Practitioner Data Bank staff, physicians withhigh numbers of medical malpractice reports in the NPDB tend to have at least someadverse actions reports (e.g. hospital disciplinary report, medical board report) andMedicare/Medicaid exclusion reports and vice versa For example the most recent NPDB


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physician has adverse action reports also increases.9 Finally, the NPDB annual reportalso notes, Physicians with at least two malpractice payment reports were responsible

for the majority of malpractice payment reports for physicians A few physiciansresponsible for a large proportion of malpractice payment dollars paid Eleven percentof physicians [in the NPDB] with at least one malpractice payment were responsible forhalf ofall malpractice dollars paid from September 1, 1990 through December 31,2006.

were

10

As can be noted from Table 3 below, our own analysis found an overall trend that as thenumber of hospital clinical privilege reports for physicians with no licensure action

increases (up to five reports), the greater the likelihood that a physician will also have amedical malpractice report. For example, 43 percent of the physicians with one clinicalprivilege report had a medical malpractice payment, whereas 61 percent of the physicianswith four clinical privilege reports had medical malpractice payments. It is noted that 57percent of all the physicians with six or more clinical privilege reports (up to 12) but nolicensure action have a history of medical malpractice payments.

Table 3

Number of Clinical Privilege Reports Percent of Physicians withSpecified Number ofClinical Privilege Reportsand No Licensure ActionWho Have at Least OneMedical MalpracticeReport

1 43.4%

2 47%

3 56.6%

4 60.8%

5 64.3%

6 through 12 57%

Exhibit D shows the number of medical malpractice payment reports for doctors withone, two, three, etc. clinical privilege reports but no licensure actions. For example, forthe 4,056 physicians with one clinical privilege report, 13 doctors had from 15 to 25medical malpractice payments, and one physician had 26 medical malpractice payments.For the 350 physicians with three clinical privilege reports, five physicians had nine ormore medical malpractice payments, including one provider with 15 payments. For the


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Table 4 below shows the general increase in the percent of medical malpractice payments

for physicians with four or more medical malpractice payouts as the number of clinicalprivilege reports per physician increases. Note that, for the most part, as the number ofclinical privilege reports increases, the percentage of those physicians with four or moremedical malpractice payouts increases.

Table 4

Number of Clinical Privilege Reports forPhysicians with no Licensure Reports

Percent withFour or More

MedicalMalpracticeReports

1 7.1%

2 9.7%

3 13.8%

4 12%

5 16.2%

6 14.8%

7 0

8 20%

9 100%

10 100%

Exhibit E provides a state-level breakdown of the following:

Number of physicians with one or more clinical privilege reports but no licensureaction

Mean number of clinical privilege reports per physician with no licensure action Maximum number of clinical privilege actions for a physician with no licensure

action

Mean number of malpractice payments per physician with clinical privilegeactions but no licensure action

Maximum number of malpractice payments for a physician with clinical privilegeactions but no licensure action

Physicians with clinical privilege reports but no licensure reports in our study not onlyhad on average almost 1.5 clinical privilege actions per physician but also had an averagef th l ti t i th i d A i thi i th i f


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State Number of Physicians with at Least 10Medical Malpractice Payments and at Least

One Clinical Privilege Report but NoLicensure Action

California 15

Georgia 13

Illinois 10

Indiana 20

Kansas 19

Michigan 14

Missouri 16New Mexico 26

New York 17

Ohio 13

Pennsylvania 23

South Carolina 15

Texas 22

Washington 12Total for all of these states 235

See Exhibit E for a state-by-state listing of the maximum number of medical malpracticepayments for a physician with clinical privilege actions but no licensure action.

Individual Physicians

To find a sample of individual physicians who had a high total of clinical privilege andmedical malpractice reports but no licensure action, we examined the NPDB Public UseFile to determine the: (1) the dates of medical malpractice reports to the NPDB and totalpayout; (2) basis for medical malpractice claims; (3) dates of clinical privilege report(s)to the NPDB; (4) reasons for reports; and (5) length of sanction for physicians with atleast one clinical privilege report and multiple malpractice reports (but no licensurereports). We identified a sample of 17 physicians in 10 states. The results of this review

are outlined in the Appendix attached to this report. Case summaries for 10 of thesephysicians (one from each state) are provided below:

California Physician # 5039 had a clinical privilege report involving suspensionof privileges in 1991 and 15 medical malpractice reports totaling $1.9 million forthe period 1993 2009 The reasons for the malpractice claims as described in the


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the malpractice claims included two cases of failing to monitor, one case ofretained foreign body, one case of misdiagnosis (surgery related), one case of

improper management (surgery related), one case of unnecessary procedure, andone case of delay in performance (surgery related); two patients died.

Illinois Physician # 12405 had a clinical privilege report in 1999 involvingpermanent denial of privileges, and 10 medical malpractice reports for the period1992-2006 totaling $7 million. The reasons for the malpractice claims includedfour cases of improper management (obstetrics related), one case of improperperformance(surgery related), one case of failure to diagnose (obstetrics related),

one case of failure to identify fetal distress (obstetrics related), one case of failureto order appropriate test (obstetrics related). One patient suffered a majorpermanent injury while another became a quadriplegic due to a brain injury.

Massachusetts Physician #16849 had seven clinical privilege reports for theperiod 2001-2004, five of which indicated permanent revocation of clinicalprivileges. The Public Use File also shows that the provider was cited forincompetence. There were three medical malpractice reports totaling $1.7 million,

two for failure to diagnose and one for delay in performance. One of the patientsincurred a major permanent injury.

Michigan Physician # 18226 had five clinical privilege reports as follows: 1997,1999, 1999, 2000, and 2000. The Public Use File showed that two of the threeadverse actions were taken for unprofessional conduct and one for incompetence.This physician also had 12 medical malpractice reports totaling $1.2 million for

the period 1992-2003. The basis for the malpractice claims included10 cases ofimproper performance (surgery related) and two cases of failure to diagnose.

New Jersey Physician # 55701 had two clinical privilege reports, one in 1994,(denial of privileges) and one in 1999 (suspension of privileges); both were forindefinite penalty length. The 1999 action was for incompetence. This practitioneralso had seven medical malpractice reports totaling $1.3 million for the period1996-2007. The reasons for the malpractice payouts included: three cases of

improper performance (surgery related), one case of improper technique (surgeryrelated) and a case of wrong diagnosis. Two patients had significant permanentinjures.

New York Physician #93487 had a clinical privilege report in 2008. Thepractitioner voluntarily surrendered privileges while under investigation and


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Ohio Physician # 30548 had five clinical privilege reports for 1992, 1993, 1995,2006 and 2008 (for substandard care). The practitioner received the following

sanctions: restriction of privileges, restriction of privileges, revocation ofprivileges, denial of clinical privileges and restriction of clinical privileges. Fouractions resulted in an indefinite penalty and one resulted in a permanent penalty.There were also six medical malpractice reports totaling $1.4 million for theperiod 1993-2001. Reasons for the malpractice payments included four cases ofimproper performance (surgery related) and one case of improper management(treatment related).

Pennsylvania Physician # 56598 had a clinical privilege report in 2006 thatresulted in suspension of clinical privileges. There were also 25 malpracticereports totaling $9.5 million for the period 19942009. The reasons for themalpractice claims included: four cases of retained foreign bodies, five casesinvolving improper performance (surgery related), two cases of unnecessarysurgical procedures, two cases of failure to obtain consent (surgery related), a caseof failure to communicate with patient (surgery related), and wrong medication(surgery related). Six patients incurred significant permanent injuries, one patient

had a major permanent injury and one patient became a quadriplegic due to braindamage.

Texas Physician # 91056 had a clinical privilege report in 2006. In addition, in2009 the practitioner had his membership suspended by a professional medicalassociation for unprofessional conduct; such a sanction is reportable to the NPDB.The physician had 22 medical malpractice payments totaling $2.6 million for theperiod 1996 2008. The malpractice claims included failure to order appropriatemedication, operating on the wrong body part, improper management, delay indiagnosis (two cases), failure to diagnose, two cases improper performance(surgery related), failure to perform procedure, two cases failure to treat (surgeryrelated), failure to recognize a complication, contraindicated procedure (surgeryrelated) and one case of wrong dosage administered. Three patients incurredsignificant permanent injuries, one patient had a major temporary injury and twopatients had minor permanent injuries.

Conclusion

Our analysis of physicians with one or more clinical privilege reports but no licensurereport raises serious questions about whether state medical boards are responding


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Why have 5,887 physicians who have had clinical privilege disciplinary actions (in onecase 12 such actions) not had any state medical board licensure action?

Why have 220 physicians who have been found by peer review to be an ImmediateThreat to Health or Safety not had a medical board action?

Why have 1,851 physicians who have had a clinical privilege action for incompetence,sexual misconduct, fraud, etc. not had a medical board action?

Why have so many physicians with a history of one or more clinical privilege actions and

multiple medical malpractice payments (in one case, 26 malpractice payments) not had astate medical board disciplinary action?

Why have 3,218 physicians who received a permanent penalty on their clinicalprivileges not had a medical board action?

Medical boards should regard clinical privilege reports as an important source ofinformation for investigating and possibly disciplining physicians for substandard care. It

is therefore troubling that 5,887 physicians with one or more clinical privilege reports(and in many cases, multiple malpractice payouts) have never had licensing boardactions. In terms of patient safety, the reason(s) for this medical board inaction needs tobe determined. Because of documented differences in the rate of disciplinary actionsamong state medical boards, it is clear that one factor is uneven medical boardperformance. If state boards are failing to properly and regularly consider hospitaldisciplinary reports that they are aware of in reviewing physician performance andconduct, state legislatures and the state executive and legislative branches should take

steps to strengthen board oversight

Another problem may be that some state medical boards may not be getting copies ofhospital disciplinary reports. As noted earlier, hospitals and other health careorganizations that report a clinical privilege action to the NPDB are required to send acopy of the report to the relevant state board. While this is typically the board of thestate in which the facility is located, other boards that may also license the physician arenot notified directly by the reporter. If this is so, National Practitioner Data Bank staffand the boards must work on fixing the reporting process. 11 Furthermore, boards canroutinely query the NPDB or use its ProActive Disclosure Service to ensure that boardsreceive hospital disciplinary reports that have been filed with the NPDB. 12

Public Citizen calls upon all state medical boards to work cooperatively with HRSA to


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Public Citizen also calls for the Office of Inspector General (OIG), Department of Health

and Human Services, to re-initiate investigations of state medical boards. During the1980s and 1990s the OIG acknowledged the importance of effective medical boardoversight; during this time period they conducted 16 evaluations of state healthprofessional licensing boards including 9 specifically addressing inadequate medicalboards performance. Because of highly questionable legal constraints imposed by OIGlawyers, the last OIG review of state medical boards was 18 years ago.


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Appendix Sample of Physicians with Clinical Privilege Report(s) and Multiple Medical Malpractice Claims

By State*

State of LastClinicalPrivilegeAction

NPDBPhysician

# fromPublic UseFile (as ofDecember

2009)

# of MedicalMalpractice

Payouts,Time Periodof Reports,and TotalPayout

Examples ofReasons forMalpracticePayments

Example of PatientHarm from

MedicalMalpractice Claims

Date(s) of ClinicalPrivilege AdverseAction Report(s)

Reasons forClinical Privilege

Action, IfAvailable

Type of Actionand Length of

Penalty, IfAvailable

California 5039 15 reports

1993-2009

$1.9 million

Improperperformance,surgery related(2); retainedforeign body (2)

Significantpermanent injury

1991 Suspension ofClinical Privileges

California 213927 15 reports

1991-2006

$478,500

Improperperformance,surgery related(8); impropertechnique, surgeryrelated (2) ; breach

of patientconfidentiality

Minor permanentinjury

1994 Reduction ofClinical Privileges

Florida 9469 10 reports

1992-2009

$1,000,000

Failure to monitor(2); unnecessaryprocedure;retained foreignbody (2); delay inperformance,surgery related;wrong diagnosis,

surgery related;impropermanagement,surgery related

Death (2 patients) 2002 (malpractice) Revocation ofClinical Privileges

Permanent Penalty

Florida 55170 9 reports

1995-2009

$795,000

Failure todiagnose (5);delay in diagnosis(3)

Death

Major permanentinjury


Permanent Penalty

Illinois 11990 10 reports

1991-1999

$2.3 million

Failure to obtaininformed consent,surgery related;delay inperformance,obstetrics related(3)

Not available inpublic use file

1994 VoluntarySurrender WhileUnderInvestigation

Illinois 12405 10 reports Impropermanagement,


1999 Denial of ClinicalPrivileges


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State of LastClinicalPrivilege

Action

NPDBPhysician

# from

Public UseFile (as ofDecember

2009)


Payouts,

Time Periodof Reports,and TotalPayout

Examples ofReasons forMalpractice

Payments


Medical

Malpractice Claims



Action, IfAvailable


Penalty, If

Available

appropriate test,obstetrics related

Massachusetts 16849 3 reports

1992-2004

$1.7 million

Failure todiagnose,obstetrics related(2); delay inperformance,obstetrics related


2001;2001;2001(incompetence); 2001;2001; 2003; 2004

Revocation ofClinical Privileges(5 reports);Reduction inClinical Privileges;Restriction ofClinical Privileges

Indefinite Penalty

Length (2);Permanent Penalty(5)

Michigan 18226 12 reports

1992-2003

$1.2 million

Improperperformancesurgery related(10); failure todiagnose (2)

Not available inpublic use file

1997(unprofessionalconduct)1999(incompetence)1999(unprofessional

conduct)2000;2000

VoluntarySurrender ofClinical PrivilegesWhile UnderInvestigation;Reduction ofPrivileges;

Suspension ofPrivileges;ReinstatementDenied

Indefinite PenaltyLength (5 times)

Michigan 2932 14 reports

1991-2005

$2.1 million

Improperperformance,surgery related(5); failure todiagnose (3);impropertechnique (3);failure to monitor


2000 VoluntarySurrender ofClinical PrivilegesWhile UnderInvestigation

Permanent Penalty

New Jersey 55701 7 reports

1996-2007

Improperperformance,surgery related

Significantpermanent injury (2patients)

1994**1999Incompetence

Denial of ClinicalPrivileges


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Action

NPDBPhysician

# from


2009)


Payouts,



Payments


Medical

Malpractice Claims



Action, IfAvailable


Penalty, If

Available

$6.2 million technique,treatment related(4); failure torecognize acomplication,

treatment related

Major temporaryinjury

Investigation

IndefiniteSuspension

New York 26295 17 reports

1991-2006

$3.3 million

Improperperformance,surgery related(8); failure todiagnose (3);wrong procedure,treatment related(1)

1994(incompetence)

Revocation ofClinical Privileges

Permanent Penalty

Ohio 30702 13 reports

1991-2006

$1.6 million

Improper

performance,surgery related(3); wrongdiagnosis; failureto orderappropriate test;delay in diagnosis

Significant

permanent injury

2002 Denial of Clinical

Privileges

Ohio 30548 6 reports

1993-2001

$1.4 million

Improperperformance,surgery related

(4); impropermanagement,treatment related

1992;1993;1995;2006;2008(inadequate/substan

dard care)

Restriction ofClinical Privileges;Restriction of

Clinical Privileges;Revocation ofClinical Privileges;Denial of ClinicalPrivileges;Restriction ofClinical Privileges

Indefinite PenaltyLength (4 cases);Permanent Penalty

(1 case)Pennsylvania 56598 25 reports

1994-2009

$9.5 million

Retained foreignbody (4); improperperformance,surgery related(5); unnecessaryprocedure, surgery


Quadriplegic, braindamage



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Action

NPDBPhysician

# from


2009)


Payouts,



Payments


Medical

Malpractice Claims



Action, IfAvailable


Penalty, If

Available

1995-2006

$4.9 million

management,obstetrics related(5); improperperformance,surgery related

(5); improperlyperformed vaginaldelivery (2);retained foreignbody

Clinical Privileges

Indefinite PenaltyLength

Texas 91056 22 reports

1996-2008

$2.6 million

Wrong body part,surgery related;impropermanagement,medication

related; delay indiagnosis (2 );failure todiagnose;improperperformance (2),failure to performprocedure, surgeryrelated; failure totreat (2); failure to

recognize acomplication,medicationrelated;contraindicatedprocedure, surgeryrelated: wrongdosageadministered.

Significantpermanent injury (3patients)

Major temporary

injury

Minor temporaryinjuries (2 patients)

2006 Revocation ofClinical Privileges

Indefinite PenaltyLength

ProfessionalSociety Action(2009)UnprofessionalConduct

* All information and data taken from NPDB Public Use File.** 1994 clinical privilege action took place when physician was licensed in South Carolina. Most recent action, 1999,

took place when physician was licensed in New Jersey*** 2009 action involved physician who had his/her membership in a professional medical association suspended for

unprofessional conduct, which is a reportable action to the NPDB


22/56

EXHIBIT A

Reason for Clinical Privilege Action (Basis For Action Codes)


23/56

Frequency Percent Valid Percent

Cumulative

PercentValid 15 .2 .2 .2

0 Basis Code Not Required 1269 14.5 14.5 14.7

01 Alcohol and Other

Substance Abuse

115 1.3 1.3 16.0

03 Narcotics Violation 20 .2 .2 16.2

05 Fraud (Unspecified) 28 .3 .3 16.6

06 Insurance Fraud

(Medicare and Other Federal

Gov. Programs)

1 .0 .0 16.6

08 Insurance Fraud (Non-

Government or Private

Insurance)

1 .0 .0 16.6

09 Fraud in Obtaining

License or Credentials

3 .0 .0 16.6

10 Unprofessional Conduct 849 9.7 9.7 26.3

11 Incompetence 165 1.9 1.9 28.2

12 Malpractice 29 .3 .3 28.6

13 Negligence 31 .4 .4 28.9

14 Patient Abuse 9 .1 .1 29.0

15 Patient Neglect 22 .3 .3 29.3

19 Criminal Conviction 24 .3 .3 29.6

20 Mental Disorder 40 .5 .5 30.0

29 Practicing Beyond Scope

of Practice

13 .1 .1 30.2

30 Allowing Unlicensed

Person to Practice

6 .1 .1 30.2

39 License Action by Fed.,

State, or Local Licensing

Authority

52 .6 .6 30.8

45 Failure to Maintain/Provide

Records or Information

78 .9 .9 31.7

basiscd1 Basis for Action [available for use 11/22/1999]


24/56


Cumulative

Percent

53 Failure to Provide Med

Resnble or Nec.

Items/Services

18 .2 .2 44.3

55 Improper or Abusive

Billing Practices

3 .0 .0 44.3

70 Violation of By-Laws,

Protocols or Guidelines [av

6/15/09]

14 .2 .2 44.5

71 Conflict of Interest 1 .0 .0 44.5

80 Physical Impairment 90 1.0 1.0 45.5

81 Misrepresentation of

Credentials

15 .2 .2 45.7

99 Other (Not Classified) 3127 35.8 35.8 81.5

A4 Practicing Without a Valid

License

4 .0 .0 81.5

A7 Surrendered License toPractice 7 .1 .1 81.6

A8 Clin Priv Restricted, Susp,

Revoked by Another

Hospital/HCF

83 1.0 1.0 82.6

AA Failure to Comply with

Corrective Action Plan

46 .5 .5 83.1

AB Practicing Beyond the

Scope of Privileges

29 .3 .3 83.4

AD Surrendered Clinical

Privileges

255 2.9 2.9 86.4

AH Didnt Comply w Probatn

or Other Requirement [av

6/15/09]

9 .1 .1 86.5

B1 Nolo Contendre Plea 2 .0 .0 86.5

C1 Failure to Obtain Informed

Consent

12 .1 .1 86.6

C3 Breach of Confidentiality 5 .1 .1 86.7

D1 Sexual Misconduct 31 .4 .4 87.0

D2 Non-Sexual Dual 3 .0 .0 87.1


25/56


Cumulative

Percent

D7 Conduct Evidencing

Ethical Unfitness [available

6/15/09]

1 .0 .0 87.2

D8 Other Unprofessional

Conduct, Specify [avail

6/15/09]

5 .1 .1 87.2

E1 Insurance Fraud

(Medicare, Medicaid or Other

Insurance)

1 .0 .0 87.2

E3 Filing False Reports or

Falsifying Records

23 .3 .3 87.5

E4 Fraud, Deceit, Material

Omssn in Obtaining License,

Crdntls

21 .2 .2 87.7

E6 Failure to Disclose

[available 6/15/09]

9 .1 .1 87.8

F1 Immediate Threat to

Health or Safety

243 2.8 2.8 90.6

F2 Unable to Practice Safely:

Alcohol or Other Substance

Abuse

34 .4 .4 91.0

F3 Unable to Practice Safely:

Psych Impairment or Mental

Dsrdr

5 .1 .1 91.1

F4 Unable to Practice Safely:Physical Illness or

Impairment

21 .2 .2 91.3

F5 Unable to Practice Safely 48 .5 .5 91.9

F6 Substandard or

Inadequate Care

491 5.6 5.6 97.5

F7 Substandard or

Inadequate Skill Level

166 1.9 1.9 99.4

F8 Fail to Consult/Delay in

Seeking Consult w

Suprvsr/Proctor

8 .1 .1 99.5

F9 Patient Abandonment 7 .1 .1 99.6

FA I i t R f l t 5 1 1 99 6


26/56


Cumulative

Percent

H1 Narcotics Violation or

Other Violation of Drug

Statutes

13 .1 .1 99.8

H2 Unauthorized Prescribing

of Medication

4 .0 .0 99.9

H3 Unauthorized Dispensing

of Medication

1 .0 .0 99.9

H4 Unauthorized

Administration of Medication

2 .0 .0 99.9

H5 Error in Prescribing,

Dispensing or Adminitering

Medication

5 .1 .1 100.0

H6 Diversion of Controlled

Substance

4 .0 .0 100.0

Total 8734 100.0 100.0


27/56

EXHIBIT B

Percent of Physicians with Clinical Privilege Actions Who Have No Licensure Action-

By State of Last Clinical Privilege Action

Percent of Physicians with Clinical Privileges Actions Who Have No Licensure Actions By State of Last Clinical


28/56

State of Last Clinical

Privileges Action

Number of Physicians with

One or More Clinical

Privileges Actions



Privileges Actions but No

Licensure Actions

Percent of Physicians Who

Have One or More Clinical


Licensure Actions

AK 30 16 53.33%

AL 137 69 50.36%

AR 114 65 57.02%

AZ 276 117 42.39%

CA 1312 710 54.12%

CO 196 62 31.63%CT 82 36 43.90%

DC 42 25 59.52%

DE 30 22 73.33%

FL 572 361 63.11%

GA 334 204 61.08%

GU 5 3 60.00%

HI 48 37 77.08%

IA 109 47 43.12%

ID 49 26 53.06%

IL 328 215 65.55%

IN 230 170 73.91%

KS 152 82 53.95%

KY 163 63 38.65%

LA 143 59 41.26%

MA 302 115 38.08%

MD 238 102 42.86%

ME 62 28 45.16%

MI 374 220 58.82%

MN 151 74 49.01%

MO 181 96 53.04%

MS 72 35 48.61%

MT 46 30 65.22%

Percent of Physicians with Clinical Privileges Actions Who Have No Licensure Actions, By State of Last Clinical

Privileges Action (National Practitioner Data Bank Public Use Data File, September 1, 1990 - December 31, 2009)

State of Last ClinicalNumber of Physicians with

O M Cli i l



Percent of Physicians Who

Have One or More Clinical


29/56

Privileges ActionOne or More Clinical

Privileges ActionsPrivileges Actions but No

Licensure Actions


Licensure Actions

OH 439 249 56.72%

OK 183 99 54.10%

OR 135 56 41.48%PA 393 276 70.23%

PR 17 17 100.00%

RI 51 23 45.10%

SC 137 75 54.74%

SD 27 19 70.37%

TN 214 150 70.09%

TX 725 438 60.41%

UT 82 44 53.66%

VA 253 113 44.66%

VI 6 6 100.00%

VT 26 11 42.31%

WA 238 124 52.10%

WI 163 98 60.12%

WV 78 36 46.15%

WY 21 10 47.62%

Total 10672 5887 55.16%


30/56

EXHIBIT C

Physicians with Specified Number of Clinical Privilege Reports by State for Physicians

with No Licensure Reports (state is state of last clinical privilege report)


31/56

Frequency Percent

1.00 3 60.0

2.00 2 40.0

Total 5 100.0

1.00 11 68.8

explanation: 11 physicians

have one clinical privileges

report from Alaska but no

licensure reports2.00 5 31.3

explanation: 5 physicians

have two clinical privileges

reports, the last of which was

from Alaska, but no licensure

reportsTotal 16 100.0

explanation: a total of 16

physicians have clinical

privileges reports, the last of

which was from Alaska, but

no licensure reports1.00 51 73.9

2.00 14 20.3

4.00 3 4.3

7.00 1 1.4

Total 69 100.0

1.00 49 75.4

2.00 11 16.9

3.00 4 6.2

5.00 1 1.5

Total 65 100.0

AZ 1.00 79 67.5

AR

Number of Physicians with Specified Number of Clinical

Privileges Reports by State for Physicians with No

Licensure Reports (state is state of last clinical

privileges report) Data Source: NPDB Public Use File,12/31/2009

State_of_last_Clin_Priv_Rpt

Statistics

AK

AL


32/56

Frequency PercentState_of_last_Clin_Priv_Rpt

Statistics

Total 117 100.0

1.00 461 64.9

2.00 159 22.4

3.00 46 6.5

4.00 24 3.4

5.00 11 1.5

6.00 2 .37.00 4 .6

8.00 1 .1

9.00 1 .1

12.00 1 .1

Total 710 100.0

1.00 45 72.6

2.00 13 21.0

3.00 3 4.8

6.00 1 1.6

Total 62 100.0

1.00 26 72.2

2.00 10 27.8

Total 36 100.0

1.00 18 72.0

2.00 6 24.0

3.00 1 4.0

Total 25 100.0

1.00 14 63.6

2.00 6 27.3

3.00 1 4.5

5.00 1 4.5

Total 22 100.0

DE

CT

DC

CA

CO


33/56


Statistics

6.00 3 .8

Total 361 100.0

1.00 142 69.6

2.00 41 20.1

3.00 15 7.4

4.00 4 2.0

5.00 1 .56.00 1 .5

Total 204 100.0

1.00 2 66.7

3.00 1 33.3

Total 3 100.0

1.00 27 73.0

2.00 8 21.6

3.00 1 2.7

5.00 1 2.7

Total 37 100.0

1.00 33 70.2

2.00 10 21.3

3.00 3 6.4

4.00 1 2.1

Total 47 100.0

1.00 20 76.9

2.00 3 11.5

4.00 3 11.5

Total 26 100.0

1.00 157 73.0

2.00 44 20.5

3.00 11 5.1

ID

IL

HI

IA

GA

GU


34/56


Statistics

3.00 11 6.54.00 4 2.4

6.00 3 1.8

10.00 1 .6

Total 170 100.0

1.00 57 69.5

2.00 16 19.5

3.00 5 6.1

4.00 2 2.4

6.00 2 2.4

Total 82 100.0

1.00 49 77.8

2.00 9 14.3

3.00 4 6.3

5.00 1 1.6

Total 63 100.0

1.00 39 66.1

2.00 14 23.7

3.00 5 8.5

4.00 1 1.7

Total 59 100.0

1.00 76 66.1

2.00 21 18.3

3.00 9 7.8

4.00 5 4.3

5.00 2 1.7

6.00 1 .9

7.00 1 .9

Total 115 100.0

MA

KY

LA

KS


35/56


Statistics

6.00 1 1.08.00 1 1.0

Total 102 100.0

ME 1.00 21 75.0

2.00 6 21.4

4.00 1 3.6

Total 28 100.0

1.00 150 68.2

2.00 53 24.1

3.00 11 5.0

4.00 4 1.8

5.00 2 .9

Total 220 100.0

1.00 48 64.9

2.00 17 23.0

3.00 3 4.1

4.00 3 4.1

5.00 2 2.7

12.00 1 1.4

Total 74 100.0

1.00 68 70.8

2.00 22 22.9

3.00 2 2.1

4.00 3 3.1

12.00 1 1.0

Total 96 100.0

1.00 27 77.1

2.00 8 22.9

Total 35 100.0

MS

MN

MO

MI


36/56


Statistics

2.00 27 20.83.00 7 5.4

4.00 2 1.5

5.00 1 .8

Total 130 100.0

1.00 11 73.3

2.00 2 13.3

3.00 1 6.7

4.00 1 6.7

Total 15 100.0

1.00 31 55.4

2.00 15 26.8

3.00 7 12.5

4.00 1 1.8

7.00 1 1.8

9.00 1 1.8

Total 56 100.0

1.00 20 71.4

2.00 5 17.9

3.00 1 3.6

4.00 1 3.6

6.00 1 3.6

Total 28 100.0

1.00 129 70.5

2.00 39 21.3

3.00 10 5.5

4.00 2 1.1

5.00 1 .5

6.00 1 .5

NJ

NE

NH

ND


37/56


Statistics

4.00 1 1.9Total 52 100.0

NV 1.00 42 49.4

2.00 24 28.2

3.00 8 9.4

4.00 3 3.5

5.00 5 5.9

6.00 3 3.5

Total 85 100.0

1.00 298 74.5

2.00 75 18.8

3.00 20 5.0

4.00 5 1.3

5.00 1 .3

8.00 1 .3

Total 400 100.0

1.00 169 67.9

2.00 61 24.5

3.00 11 4.4

4.00 4 1.6

5.00 3 1.2

7.00 1 .4

Total 249 100.0

1.00 70 70.7

2.00 17 17.2

3.00 8 8.1

4.00 1 1.0

5.00 1 1.0

6.00 1 1.0

OH

OK

NY


38/56


Statistics

4.00 2 3.65.00 1 1.8

Total 56 100.0

PA 1.00 186 67.4

2.00 65 23.6

3.00 17 6.2

4.00 6 2.2

6.00 2 .7

Total 276 100.0

1.00 15 88.2

2.00 2 11.8

Total 17 100.0

1.00 15 65.2

2.00 7 30.4

4.00 1 4.3

Total 23 100.0

1.00 44 58.7

2.00 20 26.7

3.00 8 10.7

4.00 1 1.3

7.00 1 1.3

8.00 1 1.3

Total 75 100.0

1.00 13 68.4

2.00 6 31.6

Total 19 100.0

1.00 87 58.0

2.00 37 24.7

3.00 20 13.3

TN

SC

SD

PR

RI


39/56


Statistics

3.00 28 6.44.00 7 1.6

5.00 5 1.1

7.00 1 .2

Total 438 100.0

UT 1.00 30 68.2

2.00 9 20.5

3.00 2 4.5

4.00 2 4.5

5.00 1 2.3

Total 44 100.0

1.00 81 71.7

2.00 22 19.5

3.00 8 7.1

4.00 1 .9

5.00 1 .9

Total 113 100.0

1.00 2 33.3

2.00 4 66.7

Total 6 100.0

1.00 8 72.7

2.00 2 18.2

5.00 1 9.1

Total 11 100.0

1.00 81 65.3

2.00 27 21.8

3.00 10 8.1

4.00 2 1.6

5.00 1 .8

WA

VI

VT

VA


40/56


Statistics

3.00 5 5.14.00 5 5.1

5.00 2 2.0

Total 98 100.0

WV 1.00 23 63.9

2.00 9 25.0

3.00 2 5.6

5.00 1 2.8

6.00 1 2.8

Total 36 100.0

1.00 6 60.0

2.00 3 30.0

3.00 1 10.0

Total 10 100.0

WY


41/56

EXHIBIT D

Number of Medical Malpractice Payments and Number of Physicians with SpecifiedNumber of Clinical Privilege Reports (for physician with no licensure reports)

npclprpt_mean = 1.00 THIS MEANS THE PHYSICIAN HAS ONE CLINICAL PRIVILEGES REPORT

Statisticsa


42/56

Valid 4056

Missing 0

4097.00

Frequency Percent

Valid

Percent

Cumulative

Percent.00 2295 56.6 56.6 56.6

1.00 878 21.6 21.6 78.2 e.g.: 878 physicians with clinical privileges reports but no licensure

reports have 1 malpractice payment2.00 388 9.6 9.6 87.8

e.g.: 388 physicians with clinical privileges reports but no licensure

reports have 2 malpractice payments3.00 198 4.9 4.9 92.7

4.00 117 2.9 2.9 95.6

5.00 55 1.4 1.4 96.9

6.00 46 1.1 1.1 98.1

7.00 20 .5 .5 98.5

8.00 16 .4 .4 98.9

9.00 11 .3 .3 99.2

10.00 7 .2 .2 99.4

11.00 4 .1 .1 99.5

12.00 2 .0 .0 99.5

13.00 2 .0 .0 99.6

14.00 3 .1 .1 99.7

15.00 4 .1 .1 99.8

16.00 2 .0 .0 99.817.00 2 .0 .0 99.9

18.00 1 .0 .0 99.9

19.00 1 .0 .0 99.9

21.00 1 .0 .0 99.9

22.00 1 .0 .0 100.0

25.00 1 .0 .0 100.0

26.00 1 .0 .0 100.0

Total 4056 100.0 100.0

npmalrpt_meana

Number of

malpractice

paymentreports

a. npclprpt_mean = 1.00

npmalrpt_mean

N

Sum


npclprpt_mean = 2.00 THIS MEANS THE PHYSICIAN HAS 2 CLINICAL PRIVILEGES REPORTS

Statisticsa


43/56

Valid 1250

Missing 0

1467.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 663 53.0 53.0 53.01.00 245 19.6 19.6 72.6

2.00 143 11.4 11.4 84.1

3.00 79 6.3 6.3 90.4

4.00 38 3.0 3.0 93.4

5.00 30 2.4 2.4 95.8

6.00 22 1.8 1.8 97.6

7.00 12 1.0 1.0 98.6

8.00 7 .6 .6 99.19.00 4 .3 .3 99.4

11.00 3 .2 .2 99.7

12.00 1 .1 .1 99.8

13.00 1 .1 .1 99.8

15.00 1 .1 .1 99.9

16.00 1 .1 .1 100.0

Total 1250 100.0 100.0


N

Suma. npclprpt_mean = 2.00

npmalrpt_meana

Valid

Statistics

npmalrpt_mean

npclprpt_mean = 3.00

Statisticsa


44/56

Valid 350

Missing 0

521.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 152 43.4 43.4 43.4

1.00 87 24.9 24.9 68.32.00 38 10.9 10.9 79.1

3.00 25 7.1 7.1 86.3

4.00 17 4.9 4.9 91.1

5.00 11 3.1 3.1 94.3

6.00 8 2.3 2.3 96.6

7.00 5 1.4 1.4 98.0

8.00 2 .6 .6 98.6

9.00 1 .3 .3 98.910.00 1 .3 .3 99.1

13.00 1 .3 .3 99.4

14.00 1 .3 .3 99.7

15.00 1 .3 .3 100.0

Total 350 100.0 100.0

npmalrpt_meana

Valid


Statistics

npmalrpt_mean

N



Statisticsa


45/56

Valid 125

Missing 0

207.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 49 39.2 39.2 39.2

1.00 26 20.8 20.8 60.02.00 16 12.8 12.8 72.8

3.00 19 15.2 15.2 88.0

4.00 6 4.8 4.8 92.8

5.00 2 1.6 1.6 94.4

6.00 3 2.4 2.4 96.8

7.00 1 .8 .8 97.6

9.00 1 .8 .8 98.4

11.00 1 .8 .8 99.213.00 1 .8 .8 100.0

Total 125 100.0 100.0


N


npmalrpt_meana

Valid

npmalrpt_mean


Statisticsa


46/56

Valid 56

Missing 0

102.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 20 35.7 35.7 35.7

1.00 16 28.6 28.6 64.3

2.00 7 12.5 12.5 76.83.00 4 7.1 7.1 83.9

4.00 1 1.8 1.8 85.7

5.00 2 3.6 3.6 89.3

6.00 2 3.6 3.6 92.9

7.00 2 3.6 3.6 96.4

8.00 1 1.8 1.8 98.2

12.00 1 1.8 1.8 100.0

Total 56 100.0 100.0

npmalrpt_meana

Valid


npmalrpt_mean

N



Statisticsa


47/56

Valid 27

Missing 0

34.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 13 48.1 48.1 48.1

1.00 6 22.2 22.2 70.4

2.00 4 14.8 14.8 85.2

4.00 3 11.1 11.1 96.3

8.00 1 3.7 3.7 100.0

Total 27 100.0 100.0


N


npmalrpt_meana

Valid

npmalrpt_mean


Statisticsa


48/56

Valid 12

Missing 0

18.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 4 33.3 33.3 33.3

1.00 2 16.7 16.7 50.02.00 2 16.7 16.7 66.7

3.00 4 33.3 33.3 100.0

Total 12 100.0 100.0

npmalrpt_meana

Valid


npmalrpt_mean

N



Statisticsa


49/56

Valid 5

Missing 0

7.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 2 40.0 40.0 40.0

1.00 2 40.0 40.0 80.05.00 1 20.0 20.0 100.0

Total 5 100.0 100.0


N


npmalrpt_meana

Valid

npmalrpt_mean


Statisticsa


50/56

Valid 2

Missing 0

8.00

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 4.00 2 100.0 100.0 100.0

npmalrpt_meana


npmalrpt_mean

N



Statisticsa


51/56

Valid 1

Missing 0

4.00

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 4.00 1 100.0 100.0 100.0


npmalrpt_meana


npmalrpt_mean

N


Statisticsa


52/56

Valid 3

Missing 0

4.00

Frequency Percent

Valid

Percent

Cumulative

Percent

.00 2 66.7 66.7 66.7

4.00 1 33.3 33.3 100.0

Total 3 100.0 100.0

Valid


npmalrpt_mean

N


npmalrpt_meana

EXHIBIT E


53/56

EXHIBIT E

Number of Physicians with Clinical Privilege Reports But No Licensure Reports, byState of Last Clinical Privilege Action Mean and Maximum Number of Malpractice

Reports


54/56

State of Physician's Last

Clinical Privileges Action

Number of Physicians

with Clinical Privileges

Actions but No

Licensure Action

Mean Number of Clinical

Privileges Actions per

Physician with No

Licensure Action

Maximum Number

of Clinical

Privileges Actions

for a Physician with

No Licensure Action

Mean Number of

Malpractice Payments

per Physician with

Clinical Privileges

Actions but No

Licensure Action

Maximum Number of



Clinical Privi leges

Actions but No

Licensure Action

AK 16 1.25 2 .44 2

AL 67 1.42 7 .36 4

AR 62 1.37 5 .84 9

AZ 117 1.47 6 .83 7

CA 697 1.56 12 .84 15

CO 61 1.36 6 .34 3

CT 36 1.33 2 1.28 6

DC 22 1.32 3 .27 2

DE 22 1.55 5 .95 5

FL 352 1.49 6 1.03 9

GA 202 1.46 6 .85 13

GU 3 1.67 3 .00 0

HI 38 1.39 5 .53 4

IA 46 1.39 4 1.22 7

ID 27 1.56 4 .67 6

IL 213 1.34 5 1.20 10

IN 166 1.53 10 1.54 20

KS 82 1.54 6 1.76 19

KY 58 1.34 5 1.26 8

LA 58 1.43 4 1.05 9

MA 111 1.64 7 .79 7

MD 98 1.51 8 .71 7

ME 29 1.31 4 .83 4

Number of Physicians with Clinical Privileges Reports But No Licensure Action, by State of Last Clinical Privileges Action; Mean and

Maximum Number of Clinical Privileges Actions for Physicians with No Licensure Actions; Mean and Maximum Number of Malpractice

Payments for Physicians with Clinical Privileges Actions but No Licensure Actions (NPDB, Sept. 1, 1990 - June 30, 2009)

M N b f M i N b f


55/56





Actions but NoLicensure Action



Physician with NoLicensure Action

Maximum Number

of Clinical

Privileges Actions


No Licensure Action

Mean Number of


per Physician with

Clinical PrivilegesActions but No

Licensure Action

Maximum Number of



Clinical Privi legesActions but No

Licensure Action

MI 205 1.46 5 1.37 14

MN 72 1.65 12 .54 7

MO 93 1.46 12 1.47 16

MS 33 1.27 2 .70 5

MT 31 1.35 3 .90 5

NC 130 1.41 5 .80 6

ND 15 1.47 4 .40 2

NE 55 1.84 9 1.00 6

NH 29 1.52 6 .62 3

NJ 172 1.42 8 1.08 8

NM 48 1.35 4 1.92 26

NV 81 1.98 6 1.04 9

NY 382 1.35 8 1.43 17

OH 245 1.47 7 1.24 13

OK 101 1.50 7 .85 5

OR 55 1.51 5 .78 9

PA 269 1.46 6 2.27 23

PR 16 1.13 2 1.50 6

RI 22 1.45 4 1.05 4

SC 72 1.67 8 1.11 15

SD 19 1.32 2 .79 3

TN 147 1.64 6 .97 7

TX 415 1.40 7 1.03 22

UT 40 1.48 5 1.38 6

VA 106 1.41 4 .68 6

VI 6 1.67 2 1.17 4

VT 10 1.60 5 .80 2

M N b f M i N b f


56/56





Actions but NoLicensure Action



Physician with NoLicensure Action

Maximum Number

of Clinical

Privileges Actions


No Licensure Action

Mean Number of


per Physician with

Clinical PrivilegesActions but No

Licensure Action

Maximum Number of



Clinical Privi legesActions but No

Licensure Action

WA 118 1.62 7 .94 12

WI 97 1.53 5 .61 5

WV 36 1.61 6 1.06 7

WY 10 1.50 3 1.30 3

Total 5713 1.48 12 1.08 26

Note: There is a difference between the total of 5713 physicians in Exhibit E and the total of 5887 in the report because the time period of Exhibit E

covers September 1, 1990 through June 30, 2009, whereas the time period for the 5887 physicians covers September 1, 1990 through December

31, 2009.

public citizen report

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